The ears have it

Remember to take care of your hearing, like any other aspect of your health.

When you plan your next series of maintenance health tests, don't forget your ears. An ear and hearing exam is not something that needs to be done every year, but you should be aware of changes that could signal serious problems.

"At the very least, a baseline evaluation can help, so you can monitor changes if your hearing declines," says Dr. Stephen W. Hill, an audiologist at Harvard-affiliated Massachusetts Eye & Ear.

A silent problem

At age 65, one out of three people has a hearing loss, according to the Hearing Loss Association of America, but sometimes it's not bad enough to interfere with their daily lives, so they just endure it.

But these changes can have an impact in ways you may not notice. For instance, you might have to turn up the TV louder than usual or ask people to repeat themselves, both of which can strain your personal relationships.

Poor hearing also can increase your risk of injuries, according to a study from Harvard-affiliated Brigham and Women's Hospital, published in the January 2018 JAMA Otolaryngology—Head & Neck Surgery. The researchers found that people who had reported having poor hearing were almost twice as likely to suffer from some type of accidental injury related to driving, work, or leisure or sport compared with those who said their hearing was good or excellent.

You should especially get your hearing checked if you notice any recent changes — for example, if you hear in one ear better than the other, if you experience occasional pressure or pain in your ears, or if you have tinnitus (ringing in the ears).

Sometimes hearing loss is caused by factors other than age, such as exposure to loud noises, injuries, viruses, and use of drugs like antibiotics and aspirin.

Tests and exams

Your doctor or an ear, nose, and throat (ENT) specialist can conduct a medical ear exam and hearing screening. The workup often includes the following tests:

• an examination of your ear canal and eardrum using a lighted instrument to look for any medical problems that may interfere with sound transmission

• audioscopy testing, in which your doctor places a device into your ear that generates various tones similar to soft speech to find which ones you can hear

• a Rinne test, in which the doctor holds a vibrating tuning fork outside your ear and then places it on the bone behind your ear; any difference you notice can show whether sound traveling into your ear is partially blocked from fluid, wax buildup, or a mechanical problem inside the ear

• a Weber test, in which the doctor places a vibrating tuning fork on the middle of your forehead to check if you hear the sound equally on both sides.

Getting help

If you are diagnosed with possible hearing loss, your doctor will refer you to an audiologist who will test your hearing sensitivity, which is the range of sounds you can hear.

"This is important to help understand what specific hearing difficulties you may face in the real world," says Dr. Hill. The audiologist can also look for potential middle ear problems by measuring your eardrum mobility.

If your hearing loss is significant enough, the audiologist may recommend prescription hearing aids. "But be mindful that making sounds louder does not always resolve the problem completely," says Dr. Hill.

If tests discover that speech is very unclear, even at loud levels, it may be time to discuss cochlear implants with your physician. These devices require surgery and work by bypassing damaged portions of the ear to directly stimulate the auditory nerve.

People with mild to moderate hearing loss may benefit from an up-and-coming product category called "hearables." These make sound louder, but they aren't programmed based on your hearing test.

"They're more like turning up the volume on the world around you in a general way," says Dr. Hill.

Protect your ears

No matter the status of your current hearing, you should always take steps to prevent further damage during everyday life by wearing earplugs when you attend noisy events like live sports, or when you are exposed to loud environments like a gym or large social gatherings. "Some specific earplugs, like custom musician's earplugs, can protect your ears from intense noise, but allow you to preserve a fairly high fidelity of the sound," says Dr. Hill. An audiologist can create custom earplugs for you.

Hearing loss can be a natural part of aging, but it's not the end of an active life. "There are many ways to address your hearing issues once you know the problem," says Dr. Hill. "So, if you notice any changes, don't pretend not to see the dashboard 'check engine' light. Make a point to get your ears and hearing checked on a regular basis."

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